Short-Term Dynamic Therapy
For individuals in the U.S. & U.S. territories
In Short-Term Dynamic Therapy, Dr. Donald K. Freedheim demonstrates this brief form of psychotherapy. Short-term dynamic therapy focuses on troubling feelings that stem from repressed or unresolved painful events. The aim is to provide insight as to the source of the feelings that inhibit healthy functioning. In this session, Dr. Freedheim works with a 59-year-old woman who still experiences grief surrounding several past losses.
This video features a client portrayed by an actor on the basis of actual case material.
About 2 weeks ago, Dorothy's daughter stopped by to check in on Dorothy and found Dorothy still in her robe, the house a mess, and Dorothy just sitting "like a zombie" staring at the TV. Neither Dorothy nor her daughter could believe what "a state [Dorothy] was in." At her daughter's urging, Dorothy phoned a therapist.
Dorothy had been "in a slump" for about 6 weeks. She had not been sleeping well, and she would swing from feeling agitated to feeling hopeless, but she had no idea why. Dorothy seemed to feel worse in the evenings. By the time she went to bed, she was often feeling "very bad." To compound the problem, she could only sleep for about 4 hours before awakening and then would be unable to fall asleep again for several hours. Sometimes in the middle of the night, she would lie in bed and "brood"; at other times, she would arise and try to do something to distract herself from her thoughts. Three weeks before she came to Dr. Freedheim, Dorothy had planned to visit her son and his wife and help them care for their first child, an infant, so that the couple could return to work. Dorothy had planned the trip months earlier; however, as the week of the trip approached, she began to dread it. Feeling almost desperate, she canceled the trip at the 11th hour. In lieu of going to help them, she paid for 1 month of a temporary housekeeping and nanny service, to help the couple "get it together." Having done this, Dorothy felt somewhat relieved, but overall, she felt guilty and ashamed of her behavior and of herself.
In her work, she could make her own hours, but she found that she was dreading any appointments, because she felt as if she did not want to see anyone. "What is happening to me?" she asked herself.
Dorothy recalled two other times when she had struggled with intense sadness and had to work hard to cope:
Three years ago, Dorothy's husband died unexpectedly of a heart attack. They had had a good, solid, loving, and sexual relationship for more than 35 years. They were just entering their "golden" years—successful careers, financial security, kids who were married and doing well—and they had their health, she thought. Then suddenly it was over.
Soon after her husband's death, Dorothy's mother was diagnosed with cancer, and she died 5 months later.
Dorothy felt as if she should feel that her world was crashing down, but she "carried on."
When Dorothy was in graduate school, she gave birth to her daughter. After the birth, Dorothy had a hard time coping: She experienced "postpartum blues." Dorothy attributed this depression to the fact that she was overwhelmed by another interruption in her studies, a second baby, and their already tight financial situation. Until she talked with Dr. Freedheim, she had hardly remembered "the whole thing."
Session 1: In the first session, I had Dorothy talk about the presenting problems, starting where she was comfortable. She related that she had been "in a slump" for about 6 weeks, not sleeping well and experiencing mood swings from agitation to hopelessness. I had her tell me about her current work, family, interests, and the general environment in which she lived. I tried to get as much material as possible that would be relevant to the presenting problem, along with any of her guesses as to the cause. She had no idea as to the cause and was further confused because it all came on so suddenly.
I offered reassurance that these were problems that we could deal with and that she was wise and brave to come to therapy. I also suggested that because of the rather sudden onset of the symptoms along with her good mental health history, the prognosis was good, but we needed to work to determine the causes and deal with the issues involved. I indicated that we would not need therapy for years but that we should plan a series of weekly sessions (I was not too specific, as I did not want to either alarm her or have her feel that I had all the answers), probably a dozen or so and then see where we were with the symptoms.
I did not want to frighten her into thinking that therapy would be endless, but I also did not want her to think that a quick fix was in the offing.
Session 2: After finding out how the week went and if she had any change in symptoms, I asked to go back into her history and learn more about the sudden death of her husband and about the closely followed death of her mother. I noted that within about a 2-year period, she lost three significant family members.
She then related the depressive feelings and the difficulty in leaving the hospital that she had after the birth of her second child, and I wondered whether there were associations with the ongoing problems. I suggested that there might be some connection between the onset of the current depression (when planning to help out with her first grandchild) and the experience following the birth of her second child.
She was able to find many similarities between these two events, such as the disruption each caused in her plans and her general lifestyle and the feelings of responsibility involved.
Session 3: At this time, the symptoms were a little worse, and she had had some very tough nights. She nearly called me during the week (which I encouraged, if she needed to) to ask about possible medication. I noted that the very fact that we had noticeable changes—from the first week to the next, and now back again—was in itself a clue that her feelings and behavior were in flux, possibly because of some of the discussion, memories, and feelings that we had brought up.
I also suggested that if there was a connection between the depression after her child's birth and the current one, some other concerns might be exacerbating the present depression. I lightly suggested that the closeness of her mother's illness and death, on the heels of the loss of her husband, may have interfered with some of the natural mourning process that we all must go through. I even hinted that the earlier experience involved a loss—the loss of the carried child—as well as the anticipation of responsibilities with the new baby. Because she herself was somewhat surprised by her rapid adjustment to her husband's death, she might even have had suspicions about the existence of some unresolved feelings from that event.
I suggested that it might be well to do some homework in preparation for our next session to help us understand the role of her husband's death in the present situation. I asked her to gather some memorabilia of her husband—pictures, letters, and so forth.—and review these over the week. She might even bring some pictures into the session for us to look at together.
Short-term dynamic therapy (STDT) uses the same basic principles as psychoanalytic psychotherapy, but with differing methods of practice and somewhat different goals. The purpose of STDT is to help the patient acquire insight into the role of life events and ongoing experiences that contribute to the presenting problems. An alliance with the therapist is also important, because support and guidance can help the patient through difficult conflicts.
Early in the treatment, the therapist interprets the patient's defenses, resistance, transference, and other dynamics involved in the formation of symptoms. In STDT, the therapist takes a more active role than in traditional psychoanalysis. The therapist identifies defenses early and uses interpretations to help the patient understand the role of dynamics in the formation of the symptoms as well as in the development of the treatment process.
Therapists using STDT identify thoughts and feelings of the patient that may be repressed or channeled inappropriately into actions or passivity. Such discussions can only take place within a context of trust. The patient's acceptance of interpretations may be most dependent on the relationship that is developed with the therapist. In the context of warmth, understanding, and empathy, a therapist's interpretations are more readily accepted. Emotional abreaction and negative reactions are encouraged and accepted in STDT within some limits and are used to point out the relevance of the therapeutic setting to the life problems of the patient.
In STDT, inhibited behavior and depressed feelings are interpreted as covers for repressed emotions resulting from unexpressed feelings. Patients are encouraged to re-experience some of the painful events and feelings that have gone unresolved in their lives. Precipitating events for current symptoms are identified so that larger conflicts can be recalled.
Transference in the therapeutic relationship also plays an important role in the STDT treatment process. The transference relationship is pointed out as a natural generalization from an earlier relationship, including the anticipated loss of the therapist at the completion of the intervention.
STDT can be completed in up to 10 sessions, although it is not unusual to require at least 20 sessions, depending on the dynamics of the problem.
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